A radiocirurgia é uma técnica especialmente indicada para o tratamento de lesões intracranianas pequenas. Uma das características marcantes desta técnica é a necessidade da utilização de feixes com diâmetros pequenos, dirigidos com precisão num volume alvo. O tratamento comumente utiliza feixes de fótons produzidos por aceleradores lineares (6 e 10 MV) e valores altos de dose absorvida (> 20 Gy). Este trabalho tem por objetivos principais a implementação de um Sistema de Controle de Qualidade Postal (CQP) na radiocirurgia, para avaliação da dose fornecida ao volume alvo e a precisão do posicionamento desse volume [AAPM (1995)]. Dessa forma, para garantir a consistência entre a prescrição clínica da dose absorvida e a sua administração ao paciente, um estudo da caracterização de dosímetros foi realizado, para se avaliar vantagens e desvantagens de cada um deles para os citados objetivos. Os dosímetros (Câmara de ionização (CI), Fricke (FXG), termoluminescente (TLD) e filme) foram utilizados na obtenção de parâmetros dosimétricos para campos pequenos (< 5 cm) quadrados e circulares. Dois desses dosímetros (TLD e filme) foram selecionados para aplicação no CQP na radiocirurgia, devido as suas resolução espacial, praticidade e equivalência ao tecido. Para tal, objetos simuladores (OSs) em acrílico um para avaliação dos parâmetros de campos pequenos e outro para simulação do crânio de um paciente (com um volume alvo) foram confeccionados. Irradiações postais foram feitas em 3 diferentes instituições, que fazem uso da radiocirurgia, e dessas análises pode-se concluir que o sistema postal desenvolvido pode ser utilizado para controlar feixes radiocirúrgicos em programas nacionais e internacionais de CQ na radiocirurgia. / Radiosurgery is a special technique indicated for small intracranial injuries treatment. For that, a high dose (> 20 Gy) from 6 and 10 MV fotons is delivered into a small target volume. The scope of this work is to implement a Quality Control Postal System (QCP) in radiosurgery, in order to evaluate the absorbed dose delivered to the target volume [AAPM (1995)]. In this way the consistency between the clinical absorbed dose prescription and its administration to the patient, could be guaranted. For such, a dosimeters characterization study had been carried out in order to evaluate the advantages and disadvantages of each one of the selected dosimeters (Ionization chamber (IC), Fricke (FXG), termoluminescent (TLD) and film). First they were applied to obtain small square and circular field dosimetric parameters, and latter, the two more suitable for the QCP application (as the TLD and film) were selected. Acrylic phantoms were planned and manufactured to simulate a small targed volume inserted in a human skull in order to check the precision of its position and the dose delivered. The phantom was sent to 3 different radiosurgery institutions and their shown that the QCP system is reliable to be used in national and/or international programs of quality control in radiosurgery.

Made available in DSpace on 2014-10-09T12:33:48Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:04:02Z (GMT). No. of bitstreams: 0 / Dissertação (Mestrado) / IPEN/D / Instituto de Pesquisas Energéticas e Nucleares - IPEN-CNEN/SP

Made available in DSpace on 2014-10-09T12:33:48Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T14:04:02Z (GMT). No. of bitstreams: 0 / Com o avanço tecnológico dos equipamentos utilizados em radioterapia tornaram-se possíveis o uso de alguns campos de radiação nomeados como campos pequenos em algumas modalidades especiais de radioterapia. Com isso, a dosimetria dos feixes de radiação também teve de ser revista, pois com estes novos tamanhos de campos, não há condição de referência como aquela dita nos protocolos e diretrizes de dosimetria. Neste trabalho foi realizado um estudo completo sobre os campos pequenos, bem como sua dosimetria, mostrando o comportamento dos detectores nessa nova condição de dosimetria através de uma comparação entre os detectores utilizados e dados já publicados na literatura. Além disso, os dados obtidos experimentalmente puderam ser validados através de comparação com dados publicados por outros autores. Na caracterização do detector de diamante o mesmo apresentou-se apropriado em todos os parâmetros para medidas com campos pequenos. Na análise do fator de qualidade Q os resultados experimentais obtidos nesta investigação mostraram diferenças percentuais de 1,8%; 4,0% e 4,9% para câmara do tipo CC01, CC13 e diodo estereotáxico respectivamente. Na avaliação de PDP e TMR foi possível observar a dificuldade nas medições com campos pequenos bem como na comparação de diferentes detectores, para PDP a maior diferença foi de 2,6% e para TMR 2,7%. / Dissertação (Mestrado) / IPEN/D / Instituto de Pesquisas Energéticas e Nucleares - IPEN-CNEN/SP

A radiocirurgia é uma técnica especialmente indicada para o tratamento de lesões intracranianas pequenas. Uma das características marcantes desta técnica é a necessidade da utilização de feixes com diâmetros pequenos, dirigidos com precisão num volume alvo. O tratamento comumente utiliza feixes de fótons produzidos por aceleradores lineares (6 e 10 MV) e valores altos de dose absorvida (> 20 Gy). Este trabalho tem por objetivos principais a implementação de um Sistema de Controle de Qualidade Postal (CQP) na radiocirurgia, para avaliação da dose fornecida ao volume alvo e a precisão do posicionamento desse volume [AAPM (1995)]. Dessa forma, para garantir a consistência entre a prescrição clínica da dose absorvida e a sua administração ao paciente, um estudo da caracterização de dosímetros foi realizado, para se avaliar vantagens e desvantagens de cada um deles para os citados objetivos. Os dosímetros (Câmara de ionização (CI), Fricke (FXG), termoluminescente (TLD) e filme) foram utilizados na obtenção de parâmetros dosimétricos para campos pequenos (< 5 cm) quadrados e circulares. Dois desses dosímetros (TLD e filme) foram selecionados para aplicação no CQP na radiocirurgia, devido as suas resolução espacial, praticidade e equivalência ao tecido. Para tal, objetos simuladores (OSs) em acrílico um para avaliação dos parâmetros de campos pequenos e outro para simulação do crânio de um paciente (com um volume alvo) foram confeccionados. Irradiações postais foram feitas em 3 diferentes instituições, que fazem uso da radiocirurgia, e dessas análises pode-se concluir que o sistema postal desenvolvido pode ser utilizado para controlar feixes radiocirúrgicos em programas nacionais e internacionais de CQ na radiocirurgia. / Radiosurgery is a special technique indicated for small intracranial injuries treatment. For that, a high dose (> 20 Gy) from 6 and 10 MV fotons is delivered into a small target volume. The scope of this work is to implement a Quality Control Postal System (QCP) in radiosurgery, in order to evaluate the absorbed dose delivered to the target volume [AAPM (1995)]. In this way the consistency between the clinical absorbed dose prescription and its administration to the patient, could be guaranted. For such, a dosimeters characterization study had been carried out in order to evaluate the advantages and disadvantages of each one of the selected dosimeters (Ionization chamber (IC), Fricke (FXG), termoluminescent (TLD) and film). First they were applied to obtain small square and circular field dosimetric parameters, and latter, the two more suitable for the QCP application (as the TLD and film) were selected. Acrylic phantoms were planned and manufactured to simulate a small targed volume inserted in a human skull in order to check the precision of its position and the dose delivered. The phantom was sent to 3 different radiosurgery institutions and their shown that the QCP system is reliable to be used in national and/or international programs of quality control in radiosurgery.

Com o avanço tecnológico dos equipamentos utilizados em radioterapia tornaram-se possíveis o uso de alguns campos de radiação nomeados como campos pequenos em algumas modalidades especiais de radioterapia. Com isso, a dosimetria dos feixes de radiação também teve de ser revista, pois com estes novos tamanhos de campos, não há condição de referência como aquela dita nos protocolos e diretrizes de dosimetria. Neste trabalho foi realizado um estudo completo sobre os campos pequenos, bem como sua dosimetria, mostrando o comportamento dos detectores nessa nova condição de dosimetria através de uma comparação entre os detectores utilizados e dados já publicados na literatura. Além disso, os dados obtidos experimentalmente puderam ser validados através de comparação com dados publicados por outros autores. Na caracterização do detector de diamante o mesmo apresentou-se apropriado em todos os parâmetros para medidas com campos pequenos. Na análise do fator de qualidade Q os resultados experimentais obtidos nesta investigação mostraram diferenças percentuais de 1,8%; 4,0% e 4,9% para câmara do tipo CC01, CC13 e diodo estereotáxico respectivamente. Na avaliação de PDP e TMR foi possível observar a dificuldade nas medições com campos pequenos bem como na comparação de diferentes detectores, para PDP a maior diferença foi de 2,6% e para TMR 2,7%. / With the technological equipment used in radiotherapy became possible use of some radiation fields named small fields in some special forms of radiotherapy. Thus, the dosimetry of radiation fields also had to be revised, as with these new sizes of fields, there is no reference condition such as that expressed in dosimetry protocols and guidelines. This work represents a complete study of small fields and its dosimetry, showing the behavior of the detectors in this new condition of dosimetry through a comparison between the detectors used and data already published. Moreover, the experimental data can be validated by comparison with data published by others authors. In the characterization of the same diamond detector has been considered appropriate in all parameters measured with small fields. The analysis of the beam quality factor (Q) the experimental results obtained in this study showed differences in percentages of 1.8%, 4.0% and 4.9% for chamber-type CC01, CC13 and stereotactic diode respectively. In evaluating PDP and TMR was possible to observe the difficulty in measurements with small fields and the comparison of different detectors, the biggest difference for PDP was 2.6% and 2.7% for TMR.

Com o avanço tecnológico dos equipamentos utilizados em radioterapia tornaram-se possíveis o uso de alguns campos de radiação nomeados como campos pequenos em algumas modalidades especiais de radioterapia. Com isso, a dosimetria dos feixes de radiação também teve de ser revista, pois com estes novos tamanhos de campos, não há condição de referência como aquela dita nos protocolos e diretrizes de dosimetria. Neste trabalho foi realizado um estudo completo sobre os campos pequenos, bem como sua dosimetria, mostrando o comportamento dos detectores nessa nova condição de dosimetria através de uma comparação entre os detectores utilizados e dados já publicados na literatura. Além disso, os dados obtidos experimentalmente puderam ser validados através de comparação com dados publicados por outros autores. Na caracterização do detector de diamante o mesmo apresentou-se apropriado em todos os parâmetros para medidas com campos pequenos. Na análise do fator de qualidade Q os resultados experimentais obtidos nesta investigação mostraram diferenças percentuais de 1,8%; 4,0% e 4,9% para câmara do tipo CC01, CC13 e diodo estereotáxico respectivamente. Na avaliação de PDP e TMR foi possível observar a dificuldade nas medições com campos pequenos bem como na comparação de diferentes detectores, para PDP a maior diferença foi de 2,6% e para TMR 2,7%. / With the technological equipment used in radiotherapy became possible use of some radiation fields named small fields in some special forms of radiotherapy. Thus, the dosimetry of radiation fields also had to be revised, as with these new sizes of fields, there is no reference condition such as that expressed in dosimetry protocols and guidelines. This work represents a complete study of small fields and its dosimetry, showing the behavior of the detectors in this new condition of dosimetry through a comparison between the detectors used and data already published. Moreover, the experimental data can be validated by comparison with data published by others authors. In the characterization of the same diamond detector has been considered appropriate in all parameters measured with small fields. The analysis of the beam quality factor (Q) the experimental results obtained in this study showed differences in percentages of 1.8%, 4.0% and 4.9% for chamber-type CC01, CC13 and stereotactic diode respectively. In evaluating PDP and TMR was possible to observe the difficulty in measurements with small fields and the comparison of different detectors, the biggest difference for PDP was 2.6% and 2.7% for TMR.

<p>One of the most used irradiation techniques in modern radiation therapy is step-and-shoot IMRT. The accuracy of this technique when delivering complex dose distributions strongly depends on the size of the subfields. The aims of this study is to determine the minimum size of subfields that can be used efficiently in Step-and-Shoot IMRT, to investigate the validation process for beam delivery and treatment planning dose calculations, and to find recommendations for practical clinical implementations.</p><p>Two different detectors, a CC04 ion chamber and a SFD stereotactic diode, have been used for measuring head scatter factors in air (Sc), total output factors (Scp) and dose profiles in water for a wide range of field sizes. The measurements were compared to calculations done with a pre-release version of the Nucletron MasterPlanTM v 3.1 treatment planning system that employs a novel, high resolution fluence modelling for both its pencil beam and collapsed cone dose calculation algorithms. Collimator settings were explicitly checked using FWHM film measurements with a build-up sheet of tungsten placed close to the treatment head to reduce the influence from lateral electron transport and geometrical penumbra. An analysis of the influence and sensitivity of Scp for small fields with respect to the linear accelerator source size and shape was also made.</p><p>The measurements with the ionization chamber and the stereotactic diode showed good agreements with each other and with the treatment planning system calculations for field sizes larger than 2×2 cm2. For small field sizes, measurements with different detectors yielded different results. Calculations showed agreements with measurements with the smallest detector, provided careful field size calibration and commissioning of calculation parameters. Uncertainties in collimator settings and source characteristics were shown to yield large uncertainties in Scp for fields smaller than 2×2 cm2.</p><p>The treatment planning system was found to properly handle small subfields but results were very sensitive to uncertainties in source size, as well as calibration and reproducibility of the collimator settings. Therefore if subfields smaller than 2×2 cm2 are to be used in IMRT extra care should be taken to determine the source characteristics and to calibrate the collimators. The volume of the detectors used for validation of such small fields and the loss of charged particle equilibrium conditions also have to be taken into consideration.</p>

One of the most used irradiation techniques in modern radiation therapy is step-and-shoot IMRT. The accuracy of this technique when delivering complex dose distributions strongly depends on the size of the subfields. The aims of this study is to determine the minimum size of subfields that can be used efficiently in Step-and-Shoot IMRT, to investigate the validation process for beam delivery and treatment planning dose calculations, and to find recommendations for practical clinical implementations. Two different detectors, a CC04 ion chamber and a SFD stereotactic diode, have been used for measuring head scatter factors in air (Sc), total output factors (Scp) and dose profiles in water for a wide range of field sizes. The measurements were compared to calculations done with a pre-release version of the Nucletron MasterPlanTM v 3.1 treatment planning system that employs a novel, high resolution fluence modelling for both its pencil beam and collapsed cone dose calculation algorithms. Collimator settings were explicitly checked using FWHM film measurements with a build-up sheet of tungsten placed close to the treatment head to reduce the influence from lateral electron transport and geometrical penumbra. An analysis of the influence and sensitivity of Scp for small fields with respect to the linear accelerator source size and shape was also made. The measurements with the ionization chamber and the stereotactic diode showed good agreements with each other and with the treatment planning system calculations for field sizes larger than 2×2 cm2. For small field sizes, measurements with different detectors yielded different results. Calculations showed agreements with measurements with the smallest detector, provided careful field size calibration and commissioning of calculation parameters. Uncertainties in collimator settings and source characteristics were shown to yield large uncertainties in Scp for fields smaller than 2×2 cm2. The treatment planning system was found to properly handle small subfields but results were very sensitive to uncertainties in source size, as well as calibration and reproducibility of the collimator settings. Therefore if subfields smaller than 2×2 cm2 are to be used in IMRT extra care should be taken to determine the source characteristics and to calibrate the collimators. The volume of the detectors used for validation of such small fields and the loss of charged particle equilibrium conditions also have to be taken into consideration.

Στόχος τη ακτινοθεραπείας είναι η χορήγηση της θεραπευτικής δόσης με τη μέγιστη δυνατή ακρίβεια. Αυτό συνεπάγεται τον σωστό καθορισμό της ακτινοβολούμενης περιοχής καθώς και την ακριβή εναπόθεση της δόσης. Αυτή η διπλωματική εργασία ασχολείται με την προσπάθεια για ακριβή υπολογισμό και εναπόθεση της δόσης για πεδία ακτινοβόλησης τα όποια είναι μικρότερα από 5x5cm. Όταν το μέγεθος του πεδίου μικρύνει τότε η μέτρηση και ο υπολογισμός της δόσης με κλασικές μεθόδους δε είναι πλέον ακριβείς καθώς παράγοντες όπως η πλευρική ηλεκτρονική ισορροπία, το μέγεθος και είδος του ανιχνευτή καθώς και το μέγεθος της πηγής που είναι ορατό από κάθε σημείο, πρέπει να ληφθούν υπόψη. Στη παρούσα εργασία χρησιμοποιήθηκε το λογισμικό Mephysto για να μετρήσουμε την πραγματική δόση που δίνει ο γραμμικός επιταχυντής της εταιρείας ELEKTA σε δέσμες φωτονίων ενέργειας 6 ΜV χρησιμοποιώντας έναν ανιχνευτή Pin Point της εταιρείας PTW. Στη συνέχεια συγκρίθηκαν αυτά τα αποτελέσματα (προφίλ δόσης, κατά βάθος δόση PDD) με τα αποτελέσματα που δοθήκαν από το υπολογιστικό σύστημα σχεδιασμού θεραπειών (Treatment Planning System) Oncentra Master Plan της εταιρείας Nucletron. Παρατηρήθηκε απόκλιση μεταξύ αυτών των δυο μεθόδων ελαφρώς μικρότερη του 3%. Αυτή η απόκλιση οφείλεται στο ότι ο εικονικός γραμμικός επιταχυντής που έχει δημιουργηθεί στο σύστημα Oncentra Master Plan για τον υπολογισμό της δόσης, δημιουργήθηκε ώστε να αποδίδει πλησιέστερα αποτελέσματα σε αυτά του ELEKTA για πεδία ακτινοβόλησης που έχουν μεγάλη κλινική χρήση (5 έως 15 cm αν διάσταση). Όταν όμως τα πεδία μικρύνουν (κάτω από 5cm αν διάσταση) τότε έχουμε απόκλιση από της πραγματικές τιμές. Αλλάζοντας το φαινομενικό μέγεθος της πηγής στο Oncentra Master Plan καταφέραμε να φέρουμε τους υπολογισμούς από το Oncentra Master Plan πάρα πολύ κοντά στις μετρήσεις του Mephysto. Δημιουργήθηκε έτσι ένα νέο εικονικό μηχάνημα στη βάση δεδομένων του Oncentra Master Plan με το όνομα Sli Patras SRS, οι παράμετροι του οποίου (φαινομενικό μέγεθος πηγής) έχουν βελτιστοποιηθεί για ακριβέστερους υπολογισμούς δόσης για μικρά πεδία. Με αυτό το μηχάνημα καταφέρθηκε ακριβέστερος υπολογισμός της δόσης, με αποκλίσεις μικρότερες από 1.5%, για μικρά πεδία, σε σύγκριση με το προηγούμενο μηχάνημα Sli Patra. Το νέο αυτό μηχάνημα επιτρέπει ακριβέστερους υπολογισμούς για μικρά πεδία και έχει πλέον υιοθετηθεί και χρησιμοποιείται στην κλινική ρουτίνα στο Π.Γ.Ν. Πατρών. / Small field dosimetry in sterotactic cancer radiation therapy.

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